What does this really cost?

I've become a little obsessed by the financial aspect of all this hospitalization and medical care.  I posted a rant of sorts about health insurance the night after my second surgery, and am still baffled by how health care actually works in this country.  Again, I am extremely fortunate - I have a good job with a great company that provides excellent health insurance to its employees.  I don't want to think about where I'd be if that weren't the case.  Just going through everything I've gone through so far has been stressful enough.  I can't imagine the added stress of worrying about a pile of medical bills.  It is hard to believe that we put anyone in that situation.  You can't heal with that kind of stress.

So, I'm trying to keep track.  My primary insurance provider (Blue Cross Blue Shield) sends a statement for every claim to explain how it arrived at some amount I owe a particular provider.  Sometimes I then also get a bill from the provider for that amount.  Last, I'll get a separate claim statement from my employer's supplemental insurance plan indicating that the amount has been paid.  If I have a copay for a doctor visit or medication, I pay it, and that is usually reflected as well.  This all happens without me doing anything. 

What I don't get is this idea of a "discount" that is given to the insurance company.  It's different for different things.  For example, the cost of anesthesia for my first surgery at the end of July was $1,680.  That is what the provider charged.  According to the BCBS statement, a "Blue Cross discount" was applied of 905.52 (54%), for an adjustment amount of 774.48.  Some part of this is "covered" - in this case, 619.58 (80%).  End result is that I owe 154.90 - 20% of the adjusted amount.  This charge was also considered "in network;" I assume it would be different (more) if it was out of network.

My owing 20% of the adjusted amount is consistent on the BCBS statements and in line with what I know about my policy.  But the "discount" applied is all over the place.  I expect this is what the insurance companies are negotiating with providers... does this mean the same anesthesia provided to me would cost something different if it was provided to someone with a different insurance plan?  Is Mount Auburn charging everyone the same initial cost and then all the insurance companies negotiate different discounts, for different types of costs?  How do they come up with these, how do they justify them?  How can the same anesthesia cost me one amount, and someone else another amount, just because of the insurance company we have?  Does it actually cost $1,680 for that service, or is that amount inflated because it is expected that an insurance company is going to pay some portion of it?

I've never really paid much attention to this so maybe these are naive questions.  But I really don't get it.  The insurance companies seem to have all kinds of power here, and all the money, and I think we must be getting the raw end of the deal.  It's hard to sort out.

All that said I'm really glad that anesthesia was provided.  To date, out of pocket we have spent just under $500, mostly on hospital parking.  I can't complain.  But I do worry about what other people have to go through and wonder why this works the way it does.